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Student Information:

Student First Name*:
Student Last Name*:
Student eMail*:
Student Cell Phone*:
Parent/Guardian 1 First Name*:
Parent/Guardian 1 Last Name*:
Parent/Guardian 2 First Name:
Parent/Guardian 2 Last Name:
Parent/Guardian eMail*:
Parent/Guardian eMail2:
State*: Zip*:
Home Phone*:
Work Phone:
Cell Phone:
Student Age*:
Date of Birth*:
Student Race/Ethnicity:*:
Emergency Contact Name:*: Phone*:
Relationship*: eMail*:

Primary Instrument*: Years Played*:
Other Instruments Played:
Jazz Skill Level*:
Have you attended the Litchfield Jazz Camp?*:
How did you hear of the program?*:
Please elaborate:

General Information

Select which session(s) you would like to attend:*

Hartford, CT

Fee & Location:

A fee of $500 (per session) includes the 10 classes and the final concert.

The Hartford, CT location is:
West Hartford, address provided upon registration

Taught by: Jen Allen

Feb. 28
Mar. 7, 14, 21, 28
Apr. 11, 18, 25
May 2

The final performance is TBD

Saturday's 10:00 noon

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Your information is kept confidential and used only for the purposes of
receiving information on the Litchfield Jazz Camp and Litchfield Jazz Festival.

Litchfield Performing Arts | P.O. Box 69, Litchfield, CT 06759 | Phone 860-361-6285 | Fax (860) 361-6288 | Contact Us